Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life

Abstract

Purpose: Little is known about the prevalence of combined anxiety and depressive symptoms (CADS) in breast cancer patients. Purpose was to evaluate for differences in demographic and clinical characteristics and quality of life (QOL) prior to breast cancer surgery among women classified into one of four distinct anxiety and/or depressive symptom groups.

Methods: A total of 335 patients completed measures of anxiety and depressive symptoms and QOL prior to and for 6 months following breast cancer surgery. Growth Mixture Modelling (GMM) was used to identify subgroups of women with distinct trajectories of anxiety and depressive symptoms. These results were used to create four distinct anxiety and/or depressive symptom groups. Differences in demographic, clinical, and symptom characteristics, among these groups were evaluated using analyses of variance and Chi square analyses.

Results: A total of 44.5% of patients were categorized with CADS. Women with CADS were younger, non-white, had lower performance status, received neoadjuvant or adjuvant chemotherapy, had greater difficulty dealing with their disease and treatment, and reported less support from others to meet their needs. These women had lower physical, psychological, social well-being, and total QOL scores. Higher levels of anxiety with or without subsyndromal depressive symptoms were associated with increased fears of recurrence, hopelessness, uncertainty, loss of control, and a decrease in life satisfaction.

Conclusions: Findings suggest that CADS occurs in a high percentage of women following breast cancer surgery and results in a poorer QOL. Assessments of anxiety and depressive symptoms are warranted prior to surgery for breast cancer.

Keywords: Anxiety; Breast cancer; Depression; Quality of life; Subsyndromal depression; Surgery.

Figure 1

Differences among the four anxiety and depressive symptom groups in Center for Epidemiological Studies Scale (CES-D) scores (A) and Trait and State Anxiety scores (B) at enrollment. All values are plotted as means ± standard deviations. For CES-D scores, post hoc contrasts revealed that group 0 < 1, 2, and 3 (all p≤.001) and that groups 1 and 2 < 3 (both p≤.031). For State Anxiety scores, post hoc contrasts revealed that group 0 < 2 and 3 (both p<.0001) and group 1 < 2 and 3 (both p≤.003). For Trait Anxiety, post hoc contrasts revealed that group 0 < 2 and 3 (both p≤.004) and that group 1 < 2 and 3 (both p<.0001).

Figure 2

Differences among the four anxiety and depressive symptom groups in physical, psychological, social, spiritual, and total quality of life (QOL) scores at enrollment. All values are plotted as means ± standard deviations. For the physical well-being subscale, post hoc contrasts revealed that group 0 > 1 and 3 (both p ≤.003) and that group 2 > 3 (p = .018). For the psychological well-being subscale, post hoc contrasts revealed that group 0 > 1, 2, and 3 (all p≤.028) and that groups 1 and 2 > 3 (both p≤.002). For the social well-being subscale, groups 0, 1, and 2 > 3 (all p≤.002). For the total QOL score, groups 0, 1, and 2 > 3 (all p<.0001).